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Since publishing this explosive personal account, more parents of trans youth have contacted GenderGP to share their experiences of attempting to access care from the Northern Irish youth gender clinic – Knowing Our Identity (KOI).

Northern Irish mother Sarah* has an 18 year old trans daughter, Ella. Ella was 16 when she told her parents she was trans. Sarah says they were surprised but supportive. They took Ella to their family GP who was helpful and said she would refer them to KOI.

As Ella was almost 17, Sarah was anxious about getting things moving quickly for her daughter. After waiting several weeks to hear back from KOI, Sarah took matters into her own hands and contacted them. KOI told her that they only accept referrals through CAMHS.

“We went back to the GP who made a referral to CAMHS,” says Sarah. “After a couple of appointments, they referred her to KOI but by then six months had passed. We had an appointment in April 2020, of course, COVID was prevalent so it was a telephone appointment.”

“We waited all day for the call and eventually I called them and someone told me the appointment should have been cancelled because of COVID and staff being redeployed. Ella was devastated. The specialist nurse was very helpful but basically said because Ella was now 17 and 7 months she would be transferred to adult service and it is a 5 year wait.”

Sarah wrote a letter of complaint to the Belfast Trust. She received a phone call in response. “A guy phoned me and basically said that the service was underfunded but they were trying to improve it but there was a shortage of staff, more patients … You know, the usual excuses! I said in my complaint if she had been referred to KOI why does she go to the bottom of [the] adult list. He said because she hadn’t a diagnosis that was how it was.”

Ella first went to her GP in September 2019 to ask for a referral to the gender identity clinic. At the time of publication, Ella still has not had a face-to-face appointment with the NHS. Her only contact with the staff from the gender clinic was a phone call from a nurse.


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County Antrim boy Sam* came out to his parents at the age of 13. Sam was already at Tanner stage 2 puberty at this time – his breasts were developed and he had been menstruating since the age of 12.

Sam’s family GP referred him to KOI. Sam’s mother Jane* says KOI received the referral from the GP and rejected the referral. “They rejected it without ever speaking to him/us. Their reasoning was that the Rainbow Project would be the best for him moving forward. At this stage he was binding, living as his true identity and had legally changed name. The requirements were achieved, I believe, for starting the KOI process.”

“We were persistent and after talking to a few people in the service he was put on the waiting list. His appointments were quickly established, and he chose to have me present in each appointment as that made him more comfortable.”

Jane says that she had concerns about the kind of questions the healthcare professionals were asking her son.

“The questions were ridiculous and mirrored the gender stereotypes that most people in society are trying to debunk. What toys did you play with? What clothes do you prefer? It very much dismissed anyone who didn’t meet the macho male or the feminine girl vibe.”

“My son enjoys activities such as knitting. This was discussed in a way that implied that boys don’t knit.”

Jane says that a woman who worked at KOI was critical of Sam’s interest in knitting and told him it was an activity that was ‘just for girls’. Jane was alarmed at the gender stereotyping that KOI were trying to push on her child.

KOI staff asked Jane if Sam played with ‘girls’ or ‘boys’ toys when he was younger. “I answered water/sand play, reading, football, skipping, etc. I always wondered how they gendered the water and sand play.”


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“The KOI process of questioning/gender dysphoria diagnosis etc is 100% detrimental to someone who needs support while knowing that they’re trans but also still figuring life out. I believe that he felt that he had to masc himself up more to be listened to by KOI, (while in the back of his mind thinking if I don’t pass their tests I don’t get gender-affirming treatment) in turn making him question himself with the distorted view imposed by harmful, old-school stereotypes reinforced by KOI.”

Despite KOI saying that they operate a multi-disciplinary team alongside CAMHS workers, Jane describes communication between CAMHS, KOI and her family as ‘terrible’. Sam was seeing CAMHS and KOI and Jane says that her son wasn’t listened to by his key worker at CAMHS. “At his appointments my son would say I’m ready to go back to KOI and then [at the] next appointment [the] key worker would say oh, you didn’t get back to us about whether you want to go back to KOI.” Jane says that she had to intervene and call CAMHS to get them to listen to her son and send him back to KOI.

KOI had told the family that adolescents need to be on blockers for a year before they could access gender affirming hormones. “My son got into the mindset that at 15 he would start blockers with the intention that, around his 16th birthday, he would be starting T. It wasn’t set in stone but these were the ages that he and KOI were working towards.”

Jane was uncomfortable with the idea that her son had to be on blockers for a year before he could start on testosterone. She was upset that her child, who was now three years into puberty, was having to take unnecessary puberty blockers.

“My son had completed puberty well before this age and quite frankly did not need the blockers. The blockers were another hoop to prove how serious he was about his identity. At this stage he had been out for three years and presented as a boy in every aspect of his life. There was no medical benefit for the blockers, it was just ticking boxes.”

“My son was willing to take the blockers to get onto the next stage which is testosterone and just to see that the process was moving forward. Again I think the blockers rule was like their take on gender identity: ‘You’re not an individual, these are the rules, we have to tick these boxes, even if it brings unnecessary hormonal changes, even if there’s no benefit to you we’re going to put you through it anyway’.”

When Sam was due to be referred for endocrinology, KOI got in touch to say that the timeline had been pushed back. Jane says KOI put her son’s treatment ‘on pause’ due to uncertainty over the Bell v Tavistock case.

Jane says that while Scotland’s GICs made announcements to say that Bell v Tavistock had no impact on their services, KOI made no such announcement.

Jane spoke to a KOI staff member. “She spoke openly about being ‘on the fence’ about the court case.”

Jane said this conversation was not comforting, ”There was no ‘We’re here to provide young adults and families with support and a way forward’. No advocating at all or taking responsibility for their service.”

At this stage, Jane contacted GenderGP and advised KOI that they were going to use GenderGP for their son’s healthcare, rather than KOI.

“Knowing that GenderGP is there kinda gives us the freedom to say no, we’re not using your service, we won’t be treated like that.”

We believe that no child should have to suffer in order to get the treatment they need. We hope that these stories help to show the urgent need for reform of gender identity services in the UK – and the amazing results you can achieve if trans and non-binary young people are properly supported.


Photo by Anthony Tran on Unsplash